Provider Demographics
NPI:1144324849
Name:SUDIKOFF, ERICA (LCSW)
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:SUDIKOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:G
Other - Last Name:SUDIKOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1209 SHATTUCK AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELY
Mailing Address - State:CA
Mailing Address - Zip Code:94709
Mailing Address - Country:US
Mailing Address - Phone:510-558-8450
Mailing Address - Fax:
Practice Address - Street 1:2484SHATTUCK AVE
Practice Address - Street 2:SUITE 210
Practice Address - City:BERKELY
Practice Address - State:CA
Practice Address - Zip Code:94704
Practice Address - Country:US
Practice Address - Phone:510-704-7480
Practice Address - Fax:510-704-7494
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS149951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZZ6481ZMedicare ID - Type Unspecified